P0466 - Magnetic Balloon-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgical Altered Anatomy

Alessandro Repici, MD¹, Roberto de Sire, MD¹, Marco Spadaccini, MD¹, Alessandro Fugazza, MD², Gianluca Franchellucci, MD², Matteo Colombo, MD², Marta Andreozzi, MD², Gaia Pellegatta, MD², Davide Massimi, MD¹, Antonio Capogreco, MD², Ludovico Alfarone, MD², Roberta Maselli, MD², Elisabetta Mastrorocco, MD², Cesare Hassan, MD^2
1Humanitas Research Hospital, Rozzano, Lombardia, Italy; ²Humanitas Research Hospital, Milan, Lombardia, Italy

Introduction: A 93-year-old man with a history of gastrectomy with Roux-en-Y anastomosis for a previous gastric cancer presented at the emergency room with severe cholangitis. A computed tomography scan performed in the emergency room department revealed the presence of a single stone measuring approximately 15 mm in the common bladder duct. Additionally, the computed tomography scan revealed an apparent short segment as the afferent limb, suggesting us to try to reach the major papilla in order to perform endoscopic retrograde cholangiopancreatography.

Case Description/Methods: A pediatric colonoscope (160 cm length, 11.5 mm caliber, 3.2 mm working channel with distal attachment was utilized The exploration of the y-en-Roux anastomosis was conducted through an underwater technique to prevent loop dilation (and lengthening) due to CO2 insufflation. Despite the relatively sort segment we expected, after several attempts we fail to reach the papillary region do to considerable looping, and a magnetic balloon-assisted technology device was employed. This device comprises an external magnet and a through-the-scope balloon catheter filled by a second operator with a ferromagnetic fluid contained by a preloaded syringe. When the balloon is filled with the magnetic solution, the magnet was activated and used to anchor the balloon to the abdominal wall. The balloon fixation allows the endoscopist to solve the loop through scope retraction and straightening, avoiding the scope to flip back during the process. <

Discussion: During the bowel exploration, several bowel loops were formed. Through the fluoroscopic view when the bowel loop had not solved with standard technique it was successfully solved by the magnetic balloon assisted technique. The papilla was reached after 22 minutes of exploration without significative bowel loop formation. This position allowed to cannulate the major papilla. Cannulation was performed using with a 4.4 Fr papillotomy preloaded with a 0.035 Fr guidewire. Considering the septic condition and the unstable parameters a plastic stent was placed, and a second session will be considered in a stable, elective setting. To date, this is the first reported case of a magnetic-assisted entero-endoscopic retrograde cholangiopancreatography. that has been successfully reported in the literature. This device, fitting different endoscopes, may be a useful on demand help in case of surgically altered anatomy and need of biliary access.


Disclosures:


Alessandro Repici, MD¹, Roberto de Sire, MD¹, Marco Spadaccini, MD¹, Alessandro Fugazza, MD², Gianluca Franchellucci, MD², Matteo Colombo, MD², Marta Andreozzi, MD², Gaia Pellegatta, MD², Davide Massimi, MD¹, Antonio Capogreco, MD², Ludovico Alfarone, MD², Roberta Maselli, MD², Elisabetta Mastrorocco, MD², Cesare Hassan, MD². P0466 - Magnetic Balloon-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgical Altered Anatomy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.